All children with RMS require a local control measure, which means direct treatment specifically to the site of the tumor.
- Local control can be done by surgery alone, radiation alone, or a combination of both surgery and radiation.
- The best local control option depends on the location of the tumor, how easily it can be removed with surgery, and the results of any surgery performed.
- If embryonal RMS is removed completely by surgery, and the pathologist determines the margins are clean, or negative (no cancer cells are present at the edges of the removed mass), then no further treatment measures may be necessary. In many other cases, combination with radiation therapy may be used to minimize the risk of tumor recurrence or relapse.
Only about 15-20% of patients will have visible spreading (metastasis) of RMS, but all patients are considered to have micrometastatic spread (too small for detection by radiologic tests). For this reason, chemotherapy should be used to treat all patients with RMS with the aim of eliminating micrometastatic tumor cells and decrease the likelihood of recurrence. Many different types of chemotherapy are used, and usually in combination. The specific combination selected depends on cell type, primary tumor location and extent of the disease.